Bacteriuria among Adult Non-Pregnant Women Attending Mulago Hospital Assessment Centre in Uganda

Background: Urinary tract infections (UTIs) in women are a common problem in primary health care settings. Resistance of bacterial uropathogens to commonly used antibiotics is common in many places. Objectives: To determine the prevalence of UTI; associated uropathogens and their antimicrobial susceptibility. Methods: A cross section study carried out at Mulago hospital outpatients' department. Midstream urine samples (MSU) were collected from 399 women; who gave informed consent and fulfilled other study criteria. Quantitative culture method; identification of uropathogens and antibiotic susceptibility testing using the Kirby-Bauer disc diffusion technique were applied to the isolates. Results: Out of 399 MSU samples; 40 pure significant bacterial growths (105 colony forming units (cfu)/ml of urine) were isolated and these included Escherichia coli; 23 (57.5); Staphylococcus aureus; 9 (22.5); Enterococci spp; 6 (15) and Klebsiella pneumoniae; 2 (5.0). Overall; sensitivities were: nitrofurantoin (98.3); cefuroxime (89.3); and cotrimoxazole (20) by all uropathogens isolated. Conclusions: Culture positive UTI among adult non-pregnant women are a common problem; occurring in 10of the study population. Most bacterial uropathogens showed high sensitivity to nitrofurantoin but low sensitivity to SXT. Recommendations: Nitrofurantoin should be considered as drug of choice for empirical treatment of community acquired uncomplicated UTI in adult non-pregnant women

Eligibility for HIV/AIDS Treatment among Adults in a Medical Emergency Setting at an Urban Hospital in Uganda

Background: Despite global effort to scale up access to antiretroviral therapy (ART); many people in need of HIV/AIDS care in Uganda have not been reached. HIV testing and ART are not widely offered as routine medical services and data on HIV/AIDS in emergency settings in Sub-Saharan Africa is limited.We determined the HIV prevalence and eligibility for ART in a medical emergency unit at Mulago hospital. Methods: In a cross-sectional study; we interviewed 223 patients who were systematically selected from the patients'register from October through December 2004. HIV testing was offered routinely and results were delivered within 30 minutes.We evaluated HIV infected patients for WHO clinical stage of disease and referred them for HIV/AIDS care. Results: Out of 223 patients; 111 (50) had HIV infection of whom 78 (70) had WHO clinical stage 3 and 4 of disease thereby requiring ART. Overall; 84 out of 111 (76) HIV positive patients had not received any specific HIV/AIDS care. Conclusion: The burden of HIV infection in the medical emergency unit is high and majority of the patients who required ART had no prior HIV/AIDS care.We recommend scale up of HIV/AIDS care in acute care settings in order to increase access to ART

Echocardiographic diagnosis of heart disease in Uganda

Five hundred consecutive cardiological patients were reviwed and evaluated by echocardiography in Mulago Hospital as a referral service. All diagnostic problems in cardiology in the hospital and to a certain degree from other isntitutions were reviewed. The commonest diagnosis was endomyocardial fibrosis (EMF) 19.8 ; followed by congenital heart disease (CHD) 15 and rheumatic heart disease (RHD) 11. The anatomical distribution of fibrotic lesions in EMF (left; right or biventriculat) correlated with that found in previous autopsy series from Mulago Hospital thus demonstrating the accuracy of echocardiography. We were able to quantify the contribution of echocardiography to a correct diagnosis which varied between 13in RHD to 90in mitral valve prolapse (MVP). Echocardiography was able to confirm the clinical diagnosis of subacute bacterial endocarditis (SBE in 69of cases. The obtained data suggests that EMF may be the most common heart disease in Uganda contrary to the pattern of heart disease outlined in earlier works. The favourable cost/benefit ratio of echacardiography (i.e. its easy availability and maintenance); as well as the absence of consumable materials in comparison to other cardiac diagnostic tools such as catheterization; chest X-ray and FCG is emphasized; together with the multipurpose use of the machine